Background: A major factor limiting the use of elbow arthroscopy for contracture release is concern regarding nerve injury. The purpose of this report is to document the risk of nerve injury in a large series of arthroscopic contracture releases utilizing a safety-driven strategy.
Methods: A series of 502 arthroscopic elbow contracture releases (including 388 osteocapsular arthroplasties) performed in 464 patients by one surgeon was reviewed retrospectively. The safety-driven step-wise strategy had been carried out in a standardized sequence: (1) Get In and Establish a View, (2) Create a Space in Which to Work, (3) Bone Removal, and (4) Capsulectomy. Neurologic complications were assessed and were followed until resolution.
Results: No patient had a permanent nerve injury. Twenty-four patients (5%) had a transient nerve injury, associated with prolonged tourniquet time, cutaneous dysesthesia attributed to open incisions, simultaneous ulnar nerve transposition, or retractor use. All nerve deficits resolved after one day to twenty-four months, with one patient lost to follow-up.
Conclusions: Utilizing the technique described, arthroscopic contracture release and debridement of the elbow was performed with a low risk of nerve injury.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
1Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin 10128, Italy
2New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-4037
3Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905. E-mail address for S.W. O’Driscoll: email@example.com
* Davide Blonna, MD, and Jennifer Moriatis Wolf, MD, contributed equally to the preparation of this article.